№ files_lp_4_process_1_39516
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Form to request respite care services for caregivers or care managers, with specific details for eligibility, required information, and submission guidelines.
Note:
Request Submission Date
Date of Request:
12/2022
Price: 8 / 10 USD
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Year:
2021
Region / City:
United States
Subject:
Summer program coverage for enrollees
Document Type:
Authorization request form
Organization / Institution:
HSCSN
Author:
Treating physician or nurse practitioner
Target Audience:
Enrollees and caregivers
Program Period:
Between Memorial Day and Labor Day 2021
Maximum Coverage Amount:
$2000
Covered Services:
Summer program participation only; excludes medical transport, personal care, home health, ABA, and other therapies during program hours
Submission Method:
Fax or email to HSCSN Utilization Management
Payment Options:
Reimbursement to caregiver or direct payment to program
Year:
2007
Region / city:
England, Northern Ireland, Scotland, Wales
Subject:
Adoption, Fostering, Health Assessment
Document type:
Health Report
Organization:
Agency responsible for adoption and fostering
Author:
Unknown
Target audience:
Prospective adoptive parents, foster carers, GP
Period of validity:
Not specified
Approval date:
Not specified
Date of changes:
Not specified
Year:
Not specified
Region / City:
Not specified
Theme:
Child welfare, contact and respite services
Document Type:
Form
Organization / Institution:
Not specified
Author:
Not specified
Target Audience:
Caseworkers, supervisors, carers
Period of Action:
Not specified
Approval Date:
Not specified
Modification Date:
Not specified
Year:
2018
Region / City:
Olympia, WA
Topic:
Respite Care, Disability Services
Document Type:
Procedure
Organization:
Washington State Department of Social and Health Services
Author:
Don Clintsman
Target Audience:
DDA Staff
Action Period:
Ongoing
Approval Date:
February 9, 2018
Related References:
WAC 388-845-1620, WAC 388-440-0001
Year:
2016
Region / city:
Wokingham
Subject:
Procurement, Public Sector
Document Type:
Pre-Qualification Questionnaire (PQQ)
Organization:
Wokingham Borough Council
Author:
Andy Beasley
Target Audience:
Suppliers, Contracting Authorities
Validity Period:
Until the completion of the procurement process
Approval Date:
Not specified
Date of Amendments:
Not specified
Year:
2017
Region / city:
Washington State
Topic:
Health services, nursing facilities
Document type:
Request for Information
Agency / institution:
Department of Social and Health Services, Aging and Long-Term Support Administration (ALTSA)
Author:
Aging and Long-Term Support Administration (ALTSA)
Target audience:
Skilled nursing, residential, or behavioral health providers
Period of validity:
N/A
Approval date:
N/A
Date of amendments:
N/A
Organization:
Cascadia Health
Program Names:
Tigard Adult Respite; Rockwood Respite
Document Type:
Fax cover sheet and referral process guidelines
Service Type:
Short-term mental health crisis respite
Average Length of Stay:
7–10 days
Locations:
Tigard, Oregon; Portland, Oregon
Counties Served:
Multnomah County; Clackamas County; Washington County
Contact Information:
Phone and fax numbers provided for each site
Admission Criteria:
Primary mental health diagnosis; voluntary admission; motivation for treatment; independent community navigation; need for mental health crisis support or medication management
Exclusion Criteria:
Medical needs beyond program capacity; risk of acute substance withdrawal; recent aggressive behavior; significant behavioral disturbance
Required Documentation:
Referral Screening Form; Behavioral Health Assessment and Plan or Psychiatric Evaluation; medication orders; collateral documentation
Authorization Requirements:
Enrollment with HealthShare Oregon or county authorization
Intended Audience:
Referring providers and community partners
Administrative Elements:
Fax routing fields; urgency and response checkboxes; release of information request
Note:
Year
Topic:
Disability Support, Short Term Accommodation
Document Type:
Guideline
Organization:
National Disability Insurance Scheme (NDIS)
Target Audience:
Individuals with disabilities, Carers, Support Coordinators, Local Area Coordinators
Context:
Guidelines for Short Term Accommodation (respite) funding under the NDIS, detailing eligibility, criteria, and decision-making process for temporary support.
Year:
2025
Region / City:
East Sussex
Theme:
Adult Social Care, Learning Disabilities, Respite Care
Document Type:
Job Description
Organization / Institution:
East Sussex County Council
Author:
East Sussex County Council
Target Audience:
Job Seekers, Care Workers
Period of Validity:
Ongoing
Approval Date:
February 2025
Amendment Date:
February 2025
Year:
2026
Region:
South West England
Topic:
Carer Support and Respite
Document Type:
Policy Statement
Organization:
Shared Lives South West
Author:
Shared Lives South West Board
Target Audience:
Shared Lives Carers
Implementation Period:
Ongoing
Approval Date:
Not specified
Review Cycle:
Every two years
Responsible Officer:
Chief Executive
Related Services:
Local Authority Contracts, Alternative Care Providers
Funding Source:
Management Fees from Local Authority Contracts
Year:
2026
Organization:
EFM Respite Care
Document Type:
Notice / Letter
Audience:
Respite care providers affiliated with EFM Respite Care
Purpose:
Inform provider of temporary inactivity due to noncompliance
Requirements:
Background check, CPR renewal, First Aid renewal, mandatory trainings, site visit
Deadline for compliance:
Specified in letter
Contact:
Agency representative listed in letter
Year:
2026
Location:
Whangarei, New Zealand
Position Type:
Minimum Guaranteed Hours Employment Agreement
Organization:
CCS Disability Action
Reports To:
Senior Coordinator - Respite
Purpose:
Support disabled people to live independently and participate in their community according to their Personal Plan
Key Responsibilities:
Providing personal care, administering medication, supporting children, household management, community engagement
Required Qualifications:
Careerforce Level 3 training (or willingness to complete), clean driver’s license or access to transport
Relevant Legislation:
Te Tiriti o Waitangi, UN Convention on the Rights of Disabled People, Code of Health and Disability Services
Skills:
Interpersonal skills, communication, teamwork, self-management, cultural sensitivity, service focus
Target Audience:
Disabled people and their families/whanau
Employment Conditions:
Participate in training, supervision, team meetings, complete timesheets and forms on schedule
Year:
2026
Region / City:
Not specified
Subject:
Family respite care documentation
Document Type:
Form
Organization / Institution:
Local Early Steps Program
Author:
Not specified
Target Audience:
Families receiving respite services
Period of Validity:
Per Individualized Family Support Plan authorization
Instructions:
Submit to Service Coordinator within 30 days after respite end date
Payment Terms:
Unused advance funds must be returned within 30 days if services are not provided
Definitions:
Family members include parents, siblings, aunts, uncles, grandparents, and corresponding in-laws and step-relations
Respite dates:
To be filled by family and service coordinator
Year:
2009
Region / City:
Azle, Texas
Topic:
Respite care for children
Document type:
Respite care notification and information form
Organization / Institution:
Azleway Children’s Services
Author:
Azleway Children’s Services
Target audience:
Case managers, foster parents, respite providers
Period of validity:
Not specified
Date of approval:
Not specified
Date of changes:
10/12/09
Year:
2023
Month:
January
Subject area:
Diabetes foot care
Topic:
Hospital activity and amputation indicators
Document type:
Technical document
Geographic scope:
England
Institution:
National Cardiovascular Intelligence Network
Data sources:
Hospital Episode Statistics; National Diabetes Audit; Quality and Outcomes Framework
Population:
Adults aged 18 years and over
Time period covered:
Aggregated financial years 2018/19–2020/21
Methodology:
Indicator definitions and direct age standardisation
Update history:
Methodological changes since December 2021
Intended use:
Statistical reporting and profile interpretation
Contact information:
[email protected]
Year:
Not specified
Region / City:
Atlanta, Georgia, USA
Subject:
HIV testing and prevention
Document Type:
Survey form
Organization / Institution:
Centers for Disease Control and Prevention (CDC) / ATSDR
Author:
Not specified
Target Audience:
Study participants
Study Period:
Not specified
OMB Control Number:
0920-1357
Expiration Date:
XXXXXXXX
Survey Sections:
Study staff, Participant
Year:
2025
Document code:
CHS25/008
Country:
Australia
Region:
Australian Capital Territory
Subject:
Advance Care Planning
Document type:
Guideline
Issuing organisation:
Canberra Health Services
Target audience:
CHS Network staff
Population:
Adults aged 18 years and over
Care setting:
Inpatient, outpatient, and community health services
Legal framework:
Powers of Attorney Act 2006 and relevant state and territory legislation
Related systems:
Digital Health Record
Focus areas:
End-of-life care, substitute decision-making, culturally diverse populations, disability, elder abuse
Scope:
All Canberra Health Services Network facilities and services
Jurisdiction:
Minnesota, United States
Legal basis:
Minnesota Rules parts 9555.5105, 9555.5705, 9555.6167, 9555.6225
Document type:
Placement agreement
Service setting:
Adult foster care home
Parties involved:
Resident; legal representative (if applicable); AFC license holder
Scope of services:
Lodging, food, protection, household services, personal care, safeguarding of cash resources, transportation, accessibility modifications, medication assistance
Target population:
Adults residing in licensed adult foster care homes
Regulatory references:
Vulnerable Adults Act; maltreatment reporting requirements
Structure:
Multi-part agreement with service-specific requirements and narrative descriptions
Dates referenced:
Date plan was developed; date of placement; anticipated length of placement
Year:
2015
Region / City:
Northern California / Martinez
Topic:
Medical Equipment Procurement
Document Type:
Proposal Request
Department / Institution:
Department of Veterans Affairs
Author:
Department of Veterans Affairs
Target Audience:
Contractors holding MATOC contracts with VISN 21
Effective Period:
From September 29, 2015
Approval Date:
September 29, 2015
Date of Changes:
N/A